Daily Weight Checks Could Combat Feared 'Freshman 15'

Action Points

Advise young patients about the risks of weight gain, the so-called Freshman 15, when beginning their college careers. Evidence has shown that all-you-can-eat dining halls and the high-caloric snacks sold on campus have contributed to weight gain that first year of college.

Inform patients that excess weight and obesity are risk factors for numerous chronic conditions, including cardiovascular disease and diabetes.

ITHACA, N.Y. Nov. 23 - Just as many first-year college students face a larder laden with home-cooked turkey and all the trimmings, some may be well into the dreaded "freshman 15" weight gain. But the mundane bathroom scale may help.

A weekly scale-based feedback that tracks body tissue changes could help them steer clear of the dreaded "freshman 15," according to a pair of small studies.

Using an algorithm that monitors fluctuations in body tissue on the basis of daily reported weight measurements helped female college freshman avoid gaining weight during their first semester, according to researchers at Cornell University here.

A randomized comparison of 15 female controls and 11 female students using the algorithm showed that the controls gained an average of 3.1Â± 0.51 kg (p<0.001 compared with baseline weight) during their first semester whereas the treatment group, on average, actually lost a little weight -0.7Â± 0.8 kg (p>0.4 compared with baseline), the researchers reported. This loss was not found to be statistically significant. However, the difference in weight change between the two groups was highly significant (p<0.001).

The algorithm, called Tissue Monitoring System (TMS), may be useful in retarding the current obesity epidemic in the United States, said David Levitsky, Ph.D., a professor of nutritional sciences and psychology here. It was Dr. Levitsky who documented the "freshman 15" as a real phenomenon in 2003.

"TMS appears to be an effective technique to help college freshman resist gaining weight in an environment that is conducive to weight gain," Dr. Levitsky said. "It may even be useful in curbing the slow increase in the prevalence of overweight and obesity."

The findings, to be published in a 2006 issue of International Journal of Obesity, suggest that simply checking one's weight daily could help students deter unwanted weight gain, Dr. Levitsky added.

All participants were weighed at baseline in fall 2002. The baseline mean weight of all 26 was 62.5 Â± 10.2 kg. Both the 15 controls and 11 treatment participants were advised to eat three meals a day and avoid snacks. The controls then had no further contact with the research team until they were weighed again at the end of the study.

The intervention participants were issued bathroom scales so they could weigh themselves every morning. They were not given any specific dietary or exercise instructions.

They e-mailed their weight measurements to the researchers every day. Every seven days, the investigators used the TMS algorithm to calculate a linear regression. TMS is based on the theory that over blocks of seven days, changes in body water and intestinal fill eventually cancel each other, leaving "a rather good estimate of a change in the weight of total body tissue," the authors said.

Using TMS, the research team would then email back to the participants the slope of a linear line based on that week's data to indicate whether the subject was gaining or losing body tissue. The students could then adjust their diet or exercise habits accordingly, if they decided to do so.

The difference in weight change between the two groups was highly significant (p=0.001). Only two of the 11 treatment participants gained more than 1 kg over the study period compared with 14 of the 15 controls who gained more than 1 kg, Dr. Levitsky and colleagues reported.

A second study by the authors confirmed these findings. This study also used TMS, but unlike the first study, the researchers provided the students with a value, not a slope, telling them the number of calories that they would have to add or cut to maintain their baseline weight.

In the fall of 2003, 41 female freshmen, with a mean body weight of 62.0 Â± 8.6 kg, were weighed at baseline. Twenty-four students were randomized to the control group and 17 to the intervention group.

Again, the intervention participants were issued bathroom scales and were instructed to e-mail their daily weight measurements. Again, the researchers gathered a week's worth of daily reports and calculated a linear regression, but then would email back to the subjects a value, not a slope.

The intervention group also received two one-hour lessons on how to control portion sizes at all-you-can-eat dining halls.

At the end of the 10-week semester, the students were weighed again. The controls gained an average of 2.0 Â± 0.65 kg (p<0.01) whereas the intervention group lost 0.82 Â± 0.56 kg (p>0.4). The difference in weight gain between the controls and the intervention participants was significant (p<0.01), the researchers reported. The findings from this second study were presented last summer at the Society for the Study of Ingestive Behavior meeting in Pittsburgh.

"Providing these freshmen with information about their weight with the TMS prevents this weight gain," the investigators concluded.

However, it's not clear why. Dr. Levitsky suggests "the mere act of weighing oneself daily (may be) sufficient to prevent weight gain." It's also possible that daily contact with the research team helped students avoid the "freshman 15." Previous studies have showed that individuals who have more communication with clinicians are more successful at maintaining or losing weight, the authors said.

The researchers cautioned that hopping on the bathroom scale every day could increase the risk for obsessive behaviors and possibly even eating disorders. They also noted that daily knowledge of one's weight changes "may actually prevent an eating disorder from occurring."

Dr. Levitsky said more research is needed to determine which aspects of this model helped students avoid weight gain. He said he intends to compare students who report their daily weight to another person with women who use only a computer program to track their weight changes.

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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